Drug-licensing anomalies and Parkinson's disease.
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Biomedical subjects
Publications and source records attributed to C E Bowman.
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We report the cases of three elderly patients presenting with insidious mental impairment whilst receiving both lipophilic and hydrophilic beta-adrenoceptor blocking agents (propranolol and atenolol respectively). In each case marked improvement occurred on drug withdrawal. Two of our cases probably had early senile dementia of the Alzheimer's type and continued to exhibit signs of mild mental impairment, but the third was restored to normal functioning. We found no evidence of impaired perfusion to suggest a vascular basis for the effect or of depression. We believe that beta-blockade may cause or exacerbate mental impairment in the elderly.
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A representative sample of 351 patients in Private Nursing Homes in Weston Super Mare was surveyed with regard to their origins, admission assessment and continuing care, with particular reference to the nature of medical review during their residency. The results suggest inadequate medical care especially for 'imported' patients and those admitted for psychiatric reasons.
Nineteen hydrolytic enzymes were detected in individual adult Pergamasus longicornis (Berlese) mites--amylase, hide protease, alkali phosphatase, esterase (C4), esterase lipase (C8), lipase (C14), leucine arylamidase, valine arylamidase, cystine arylamidase, acid phosphatase, phosphoamidase, alpha-galactosidase, beta-galactosidase, beta-glucuronidase, alpha-glucosidase, beta-glucosidase, N-acetyl-beta-glucosaminidase, alpha-mannosidase, and alpha-fucosidase. All but the phosphatases were detected for the first time. Tryptic and chymotryptic activity were consistently not demonstrable. Comparisons are made with saprophagous mites. No clear enzymic specialization for predation was found.
A case of fatal creosote poisoning is described. On presentation, extensive oropharyngeal ulceration was noted and gastric lavage withheld. Post-mortem examination showed an intact oesophagus and stomach.
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To assess problems of care in a private nursing home an observational study was carried out over two months, during which a research nurse worked as a member of the staff in a home caring for 25 patients aged 62-90. During the second month a consultant physician visited the home weekly to hold case conferences and assess each patient's functional ability and drug regimen. Various problems in medical, nursing, and bureaucratic matters were identified--for example, staff failed to understand the appropriate response to various medical symptoms; no clear policy existed for managing pressure sores; and one patient's anticoagulant state could not be assessed when industrial action meant that transport to take him to hospital was not available--and several changes in drug treatments were recommended. The problems that were identified were mainly due to poor communication between the home and general practitioners and hospitals and to the lack of guidance policy on common issues that arise in long term care. Such a policy could be produced by health authority staff, general practitioners, and representatives of nursing homes.
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